Sputum microscopic examination Bringing back smiles with DOTS Patient-wise boxes of drugs A DOT provider Central TB Divison Directorate General of Health Services Ministry of Health and Family Welfare Nirman Bhawan, New Delhi - 110011 http://www.tbcindia.org TB India 2007 RNTCP Status Report TB Anywhere is TB Everywhere - Stop TB Now Central TB Division Directorate General of Health Service Ministry of Health and Family Welfare Nirman Bhavan, New Delhi - 110 011 http://www.tbcindia.org This publication can be obtained from Central TB Division Directorate General of Health Services Ministry of Health and Family Welfare Nirman Bhavan, New Delhi 110011 http://www.tbcindia.org ISBN 81-902652-2-9 March 2007 © Central TB Division, Directorate General of Health Services LokLF; ,oa ifjokj dY;k.k ea=h Minister of Health & Family Welfare Hkkjr ljdkj] Government of India fuekZ.k Hkou] ubZ fnYyh&110 011 Nirman Bhavan, New Delhi - 110 011 MkW vUcqe.kh jkenkl Dr. Anbumani Ramadoss FOREWORD I am extremely pleased to know that the Revised National TB Control Programme (RNTCP) has achieved 100% geographical coverage of the country under DOTS in March 2006 and has also consistently achieved the global target of treatment success rate of over 85% and that the case detection rate has been close to the global target of 70%. RNTCP has been recognised internationally for the fastest expansion in the history of DOTS implementation. I am happy that the achievements of RNTCP have been lauded on the international stage forum. India has the distinction of implementing the largest TB control programme in the world, which detects and put on DOTS more than 100,000 patients every month. Since the inception of the programme, about 6.7 million patients have been initiated on treatment, thereby saving more than 1.2 million additional lives. In 2004, 22% of the new infectious cases notifi ed globally were from India. In October 2006, the Government of India invited a panel of international experts from the fi elds of public health, TB research and treatment, and other related fi elds to review the performance of the programme. Th is is the third such Joint Monitoring Mission (JMM) to review the RNTCP. Th e mission observed that “Programme service delivery is well integrated into the health system; tuberculosis care is provided by general health staff . Th e programme organisation has been established at all levels. External quality assessment has been implemented in the microscopy network. Th ere is an excellent system of recording and reporting, with indicators for monitoring and evaluation...” Th e Mission was impressed with the Government of India’s eff orts and has made several recommendations to further improve the programme, such as strengthening human resources at the central unit, promote eff ective service delivery and integration with NRHM, including prioritising the starting of management of MDR-TB at the earliest. RNTCP is currently taking steps to address these recommendations. Combating TB is a long-term but a winnable battle. Th is year’s theme for World TB Day that “TB anywhere is TB everywhere” also points towards directing eff ort towards a TB-free India. Let us pledge to continue our eff orts to fi ght against tuberculosis. We need to strengthen the core capacity of all those involved in programme implementation. Th ere is also an urgent need to improve standardised treatment practices based on international guidelines for TB treatment both in the public sector and more so in the private sector. Th is can be achieved by linking all such health care providers to RNTCP and proactively building a working relationship with the other sectors. Th e programme has also put mechanisms in place to make services accessible, acceptable and aff ordable through partnership with the community based organisations and greater community participation and empowerment. Th is is the seventh annual report of RNTCP being published, at a juncture when the programme has made considerable achievements, established TB/HIV collaborative activities for cross referral linkages between the two programmes, and identifi ed thrust areas in the second phase of RNTCP, backed by the critical observations of the JMM to improve programme eff ectiveness. Concerted eff orts are needed from the Government and all partners to sustain the achievements and eff ectively implement the additional planned activities. Myself and my Ministry are fully committed to continue and intensify the eff orts to combat TB in India. I hope that all individuals and agencies involved in TB control in India will continue to work with high levels of dedication and commitment to achieve the ultimate goal of a TB-free India. March 2, 2007 (Dr. Anbumani Ramadoss) TB India 2007 3 Abbreviations ACSM Advocacy, Communication and Social Mobilisation ADGHS Assistant Director General of Health Services AIDS Acquired Immune Defi ciency Syndrome AIIMS All India Institute of Medical Sciences ARTI Annual Risk of Tuberculosis Infection ASHA Accredited Social Health Activist BCG Bacillus Calmette-Guerin (antituberculosis vaccine) BPHC Block Primary Health Centre C&S Care and Support CDC Centres for Disease Control and Prevention CGHS Central Government Health Scheme CHAI Christian Health Association of India CHC Community Health Centre CII Confederation of Indian Industries CMAI Christian Medical Association of India CSC Central Steering Committee CTD Central Tuberculosis Division DANIDA Danish International Development Assistance DDG Deputy Director General DFID Department for International Development DGHS Directorate General of Health Services DMC Designated Microscopy Centre DOTS Directly Observed Treatment Short-course DRS Drug Resistance Surveillance DST Drug Sensitivity Testing DTC District Tuberculosis Centre 4 TB India 2007 DTCS District TB Control Society DTO District Tuberculosis Officer E Ethambutol EQA External Quality Assessment GMSD Government Medical Stores Depot GoI Government of India H Isoniazid HIV Human Immunodeficiency Virus HRD Human Resource Development ICMR Indian Council of Medical Research IEC Information, Education and Communication IMA Indian Medical Association IRL Intermediate Reference Laboratories ISM&H Indigenous System of Medicine and Homeopathy IUATLD International Union Against Tuberculosis and Lung Disease JMM Joint Monitoring Mission KAP Knowledge, Attitude and Practices LT Laboratory Technician MDG Millennium Development Goals MDR-TB Multi Drug-resistant TB (resistance to at least rifampicin and isoniazid) MIS Management Information System MO Medical Officer MoHFW Ministry of Health and Family Welfare MOTC Medical Officer-Tuberculosis Control MoU Memorandum of Understanding NACO National AIDS Control Organisation NACP National AIDS Control Programme NGO Non Governmental Organisation NRHM National Rural Health Mission NRL National Reference Laboratories NTF National Task Force NTI National Tuberculosis Institute NTP National Tuberculosis Programme OR Operational Research OSE On-site Evaluation TB India 2007 5 PHC Primary Health Centre PL Peripheral Laboratory PP Private Practitioner PPM Public-Private Mix PSU Public Sector Units PTB Pulmonary Tuberculosis PWB Patient-wise Boxes QA Quality Assurance R Rifampicin RBRC Random Blinded Re-Checking RNTCP Revised National Tuberculosis Control Programme SDS State Drug Stores SMC Screening and Monitoring Committee STC State TB Cell STDC State Tuberculosis Training & Demonstration Centre STF State Task Force STLS Senior Tuberculosis Laboratory Supervisor STO State Tuberculosis Officer STS Senior Treatment Supervisor TB Tuberculosis TPIS Tuberculosis Programme Information System TRC Tuberculosis Research Centre TU Tuberculosis Unit USAID United States Agency for International Development VCTC Voluntary Testing and Counselling Centres WHO World Health Organization Z Pyrazinamide ZTF Zonal Task Force 6 TB India 2007 Contents Foreword 3 Abbreviations 4 RNTCP Overview 2006 8 Chapter 1 TB: Burden of the Disease in India 10 Chapter 2 Stop TB Strategy 14 Chapter 3 Activities in 2006 21 Chapter 4 Joint Monitoring Mission 53 Chapter 5 Success Stories 57 Chapter 6 Research Activities 63 Chapter 7 Performance of RNTCP 71 TB India 2007 7 RNTCP OVERVIEW 2006 ndia is a large country with a vast and divergent PUBLIC PRIVATE MIX public sector complemented by an equally large Over 2,200 Non Governmental Organisations private sector. There are states with good socio- (NGOs), 14,500 private practitioners, and 120 Idemographic and health indicators on the one hand, corporate houses are involved in the provision as well as states with poor economic conditions on the of RNTCP services. other. Delivering equitable health care in such diverse Presently, 234 medical colleges (including conditions is a challenge which the government faces private colleges) are involved in RNTCP and in every health programme. contributing nearly 10–15% of case detection in their respective districts. The Revised National Tuberculosis Control Programme Health facilities in government sectors outside (RNTCP) has been implemented in the country for the Health Ministry have been involved, namely close to a decade now, and more than 6.7 million Employees State Insurance (ESI), Railways, Ports patients have been put on Directly Observed Treatment and the Ministries of Mines, Steel, Coal, etc. – Short Course (DOTS). It has geographically Collaboration for increased participation of expanded to achieve nation-wide coverage in March all sectors in RNTCP is being strengthened 2006, while maintaining a success